Anxiety, mood, and substance use disorders in adult men and women with and without attention-deficit/hyperactivity disorder: A substantive and methodological overview
- PMID: 37149075
- DOI: 10.1016/j.neubiorev.2023.105209
Anxiety, mood, and substance use disorders in adult men and women with and without attention-deficit/hyperactivity disorder: A substantive and methodological overview
Abstract
Knowledge on psychiatric comorbidity in adult ADHD is essential for prevention, detection, and treatment of these conditions. This review (1) focuses on large studies (n > 10,000; surveys, claims data, population registries) to identify (a) overall, (b) sex- and (c) age-specific patterns of comorbidity of anxiety disorders (ADs), major depressive disorder (MDD), bipolar disorder (BD) and substance use disorders (SUDs) in adults with ADHD relative to adults without ADHD; and (2) describes methodological challenges relating to establishing comorbidity in ADHD in adults as well as priorities for future research. Meta-analyses (ADHD: n = 550,748; no ADHD n = 14,546,814) yielded pooled odds ratios of 5.0(CI:3.29-7.46) for ADs, 4.5(CI:2.44-8.34) for MDD, 8.7(CI:5.47-13.89) for BD and 4.6(CI:2.72-7.80) for SUDs, indicating strong differences in adults with compared to adults without ADHD. Moderation by sex was not found: high comorbidity held for both men and women with sex-specific patterns as in the general population: higher prevalences of ADs, MDD and BD in women and a higher prevalence of SUDs in men. Insufficient data on different phases of the adult lifespan prevented conclusions on developmental changes in comorbidity. We discuss methodological challenges, knowledge gaps, and future research priorities.
Keywords: Adults; Anxiety disorders; Attention-Deficit/Hyperactivity Disorder; Bipolar disorder; Comorbidity; Life course; Lifespan; Major depressive disorder; Sex differences; Substance use disorders.
Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Conflicts of interest KK, SD, QC, BC, MV report no conflicts of interest. CAH has received speaker’s honoraria for Medice. HL reports receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma AB; and sponsorship for a conference on attention-deficit/hyperactivity disorder from Shire/Takeda Pharmaceuticals and Evolan Pharma AB, all outside the submitted work. Henrik Larsson is editor-in-chief of JCPP Advances. BL is employed at Janssen-Cilag AG, which however has no connection to this work. EDR has served as a speaker for Shire Sweden AB outside the submitted work. SC declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), British Association of Pharmacology (BAP), and from Healthcare Convention for educational activity on ADHD. SKS has received speaker’s and authors’ honoraria from Medice Arzneimittel Pütter GmbH Co KG and Takeda. JH has received speaker’s honoraria from Medice, Shire and Takeda. BSS has received authors’s honoraria from Takeda. AR has received honoraria from and/or serves on advisory boards for Medice, Shire/Takeda, SAGE/Biogen, Janssen, Boehringer Ingelheim and cyclerion. SF received, In the past year, Dr income, potential income, travel expenses continuing education support and/or research support from Aardvark, Aardwolf, Tris, Otsuka, Ironshore, KemPharm/Corium, Akili, Supernus, Atentiv, Noven, Sky Therapeutics, Axsome and Genomind. With his institution, he has US patent US20130217707 A1 for the use of sodium-hydrogen exchange inhibitors in the treatment of ADHD. He also receives royalties from books published by Guilford Press: Straight Talk about Your Child’s Mental Health, Oxford University Press: Schizophrenia: The Facts and Elsevier: ADHD: Non-Pharmacologic Interventions. He is Program Director of www.ADHDEvidence.org and www.ADHDinAdults.com.
